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WAL-MART PHARMACY 10-5997
CHC26573-00 TRAVERSE HEALTH CLINIC AND COALITION
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Covered Entity Details
Entity Name
TRAVERSE HEALTH CLINIC AND COALITION
Subdivision Name
Traverse Health Clinic and Coalition
Type
HRSA-Funded Health Center
340B ID
CHC26573-00
Entity Address
1719 S. Garfield Ave.
Traverse City, MI 49686
Grant Number
H80CS26573
Participating Start Date
4/1/2017
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Arlene Brennan, CEO
(231) 642-5935
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/17/2018
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